经骶1骶髂螺钉进钉点与臀上动脉解剖关系的CT多平面重组与三维重建研究

doi:10.3760/cma.j.issn.2095-7041.2015.04.006

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摘要目的对臀上动脉骨盆外分支的走行与经骶1(S₁)骶髂螺钉进钉点区域的关系进行放射解剖学研究,为临床置钉时避免损伤臀上动脉提供解剖学基础和技术参考。方法前瞻性研究。2013年1月—2014年8月,以128层螺旋CT对山东省烟台市烟台山医院74例可疑腹盆部血管病变的成人患者(男女各37例)进行CTA检查,并对臀上动脉进行成像。使用CT自带测量软件确定骨盆标准侧位观上S₁节段的骨性安全进钉区域(简称安全区)。观察臀上动脉盆外各分支与安全区之间的关系,统计动脉与安全区相交的样本数量,对臀上动脉分支未与安全区相交的样本,测量最接近安全区的臀上动脉分支与安全区的最近距离。结果 74例中3例没有S₁水平方向置钉的骨性通道,被排除在本研究范围之外。余71例中有32例臀上动脉深上支穿经S₁进钉点安全区 (45.1%)。臀上动脉深上支与安全区无明显的重叠特征和规律。臀上动脉与进钉点不相交的39例中,臀上动脉深上支是距离安全区最近的动脉分支,其走行最接近安全区的部分位于安全区最宽部分的前方。安全区与臀上动脉深上支的最近距离为(0.86±0.84)cm。结论 S₁骶髂螺钉置钉过程中误伤臀上动脉深上支的风险高。即使进钉点位于骨性安全区,也无法保证置钉的安全。因此,临床置钉术前应制定周密的应对方案。

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	李京宁
	赵勇
	廉伟
	邹德鑫
	孙涛
	张树栋
	王丹
	谭江威
	赵宇驰
	曲文庆

关键词 ：体层摄影术,螺旋计算机, 骨盆, 臀上动脉, 血管造影术, 骶髂螺钉, 解剖

Abstract：Objective To provide the anatomical basis for avoiding damage to the superior gluteal artery in the sacroiliac screw placement horizontally, by means of radiologic anatomy study on the anatomical relationship between the first sacral vertebral(S₁) sacroiliac screws′ entry points and the pelvic outer superior gluteal artery branches.Methods Seventy-four superior gluteal artery CTA vascular images of adults (37 women and 37 men) were done with 128-slice spiral CT. The CT attendant measuring software was used to portray the "safe bony entrance area"(short for "safe area") of the S₁ segment in the standard lateral pelvic view of three dimensional reconstruction. The anatomical relationship between S₁ sacroiliac screws′ safe area and the pelvic outer superior gluteal artery branches was observed and recorded. The number of cases in which artery branches intersected the safe area was counted. The cases in which superior gluteal artery branches disjointed from the safe area were chosen and measured. And the measuring point was the nearest distance between the safe area and the superior gluteal artery branch closest to the safe area.Results Among the 74 cases, 3 cases were found no bony space for horizontal screw placement in S₁ segment, so they were excluded from this study. Among the remaining 71 cases, there were 32 cases(45.1%)whose the deep superior branch of superior gluteal artery passed through the safe area of S₁ entrance point. There were no distinguishing feature and regularity of the overlap of the deep superior branches and the safe area. In the 39 cases in which superior gluteal artery branches disjointed from the safe area, the deep superior branches of superior gluteal artery were the branches closest to the safe area. And the part of the branch closest to the safe area located in front of the widest part of the safe area. The nearest distance between the deep superior branch and the safe area was (0.86±0.84)cm.Conclusions There is a high risk of accidental injury of the deep superior branches of superior gluteal artery in the process of S₁ sacroiliac screw placement. Even entry points are located in the safe bony entrance area, the secure placement cannot be assured absolutely. We suggest that great attention must be paid to makeing thorough preoperative plans.

Key words： Tomography, spiral computed Pelvis Superior gluteal artery Angiography Sacroiliac screw Anatomy

收稿日期: 2014-12-28

基金资助:国家自然科学基金(81301553);山东省优秀中青年科学家科研奖励基金(BS2013SF015);烟台市科技发展计划项目(2013WS234)

通讯作者: 赵勇, Email: nihaoedde@126.com E-mail: nihaoedde@126.com

引用本文:

李京宁,赵勇,廉伟,邹德鑫,孙涛,张树栋,王丹,谭江威,赵宇驰,曲文庆. 经骶1骶髂螺钉进钉点与臀上动脉解剖关系的CT多平面重组与三维重建研究[J]. 中华解剖与临床杂志, 2015, 20(4): 306-309.
Li Jingning, Zhao Yong, Lian Wei, Zou Dexin, Sun Tao, Zhang Shudong, Wang Dan, Tan Jiangwei, Zhao Yuchi, Qu Wenqing.. Study on anatomical relationship between the first sacral vertebral sacroiliac screws′ entry points and superior gluteal artery with CT multi-plane reformation and three-dimensional reconstruction technology. Chinese Journal of Anatomy and Clinics, 2015, 20(4): 306-309.

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